Healthcare Provider Details

I. General information

NPI: 1144226309
Provider Name (Legal Business Name): MICHAEL STEVEN BRYANT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 03/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1841 QUIET CV
FAYETTEVILLE NC
28304-3857
US

IV. Provider business mailing address

1841 QUIET CV
FAYETTEVILLE NC
28304-3857
US

V. Phone/Fax

Practice location:
  • Phone: 910-323-2626
  • Fax: 910-323-3862
Mailing address:
  • Phone: 910-323-2626
  • Fax: 910-483-6367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number39244
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: